Disc pain is one of the most common reasons people seek Chiropractic treatment. Over the years the dreaded disc seems to have been villainized, resulting in a host of misconceptions about the condition. In reality; while disc injury and bulging can cause severe pain and discomfort, most of the time it can be managed simply, and most people will recover within 6-8 weeks of conservative treatment.
Intervertebral discs are shock absorbing cushions that lie between the back bones (vertebrae) that make up your spine. Like Onions (and Shrek) discs have layers. These layers wrap around a jelly center called the nucleus. Only the outer layers of the disc contain nociceptive nerve endings which are able to send messages to the brain to alert it of tissue damage.
Damage to the discs is mainly caused by abnormal spinal loading, or in simpler terms: too much stress on your back in ways that it is not designed to handle. Prolonged sitting (driving and desk jobs), trauma, weight-bearing sports (weight lifting) and poor lifting techniques are a few mechanisms by which the spine can be “over-loaded”. Interestingly, smoking is another risk factor for disc injuries.
The consequence of overloading and poorly nourished tissue is that the layers of the disc surrounding the jelly center begin to develop tiny tears. Repetitive micro tearing over time can lead to bigger tears called fissures, which can eventually extend into the outer third of the disc causing pain. If the fissure is long enough, the jelly center seeps through it causing the disc to bulge outward. In some cases this bulge puts pressure on the nearby spinal nerve root, causing a painful sensation to shoot along the course of that nerve. Depending how much pressure the bulge puts on the nerve; weakness, numbness and tingling may also be experienced. The extent of the bulge is also affected by movements like bending forward and twisting; which is why these movements cause so much pain when the disc is injured. Coughing and sneezing can also increases the disc bulge and often results in sudden, sharp pain.
This condition is commonly known as a “slipped disc”, although I prefer the term “Bulging disc”, because the disc does not actually become unhinged and move anywhere.
Now that you have a good understanding of what is happening in the structure of the disc when it is injured…it’s time to put some misconceptions to rest!
You should not exercise if you have a bulging disc.
There are certain movements which will certainly need to be limited temporarily, but specific exercises which unload the disc are one of the most effective ways to manage disc pain! Instead of cutting out exercise completely, time should be taken to show you which movements to avoid, and to help correct abnormal movement patterns and lifting techniques that caused the injury in the first place.
Most people who have disc problems need surgery.
Surgery is only required in very rare cases when the disc bulge severely impedes the nerve function. Almost 90% of cases either resolve on their own or are well managed with conservative treatment, with some cases requiring pharmacological interventions (drugs) as well. An interesting point to note here is that the amount and severity of pain you experience does not indicate the severity of damage to your disc and nerve, and does not mean that the likelihood of you needing surgery is higher. Sometimes minimal damage can cause severe pain and severe damage can cause very little pain. This is why it is always important to get a professional to examine you.
Everyone who has a bulging disc experiences pain.
Imaging studies have shown that 19-27% of people with a disc bulge do not have any pain symptoms! This means that if four people with no pain have an MRI done; roughly 1 out of these people will have a disc bulge that they are completely unaware of.
Once your disc is bulging it will stay that way forever.
The bulging portion of the disc actually tends to regress over time with partial or complete resolution in 2/3 people in a 6 month period.
So What Next?
Since most people are not happy to be in pain for six months while the disc naturally heals, conservative treatment to help control the pain along the way is popular! Pain control is necessary not only from a comfort point of view, but also to combat compensatory movement patterns that the body adopts in an attempt to take pressure off the painful disc. If these patterns stick around long enough, they themselves can end up causing painful conditions in other areas.
The main aim of conservative treatment is thus to get rid of as much of your pain as possible, improve the way you move and function, minimize the negative effects of the experience of pain on your body, and get you to a point where you can enjoy doing the things you love to do! Most of the time this can be achieved with the use of specific exercises and stretches, temporary restriction of specific movements, manual manipulations and soft tissue work and localized icing of the affected area. In some cases people require a course of anti-inflammatories and muscle relaxants as well.
Of course a big part of treatment will also be aimed at identifying and correcting the risk factors that lead to the development of your disc injury to try prevent the injury from happening again. This you could call the “rehabilitation” phase.
Disc injuries are a lot less daunting and scary than they are sometimes perceived to be. With a dash of knowledge, a splash of discipline and a pinch of patience you have the recipe to getting back to doing the things you love and enjoying the life you live- hopefully stronger than ever before!
Move Well. Live Well.